Provider Demographics
NPI:1912418625
Name:PRYOR, MADISON (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:INGALLS
Mailing Address - State:IN
Mailing Address - Zip Code:46048-9530
Mailing Address - Country:US
Mailing Address - Phone:317-809-2405
Mailing Address - Fax:
Practice Address - Street 1:8205 E 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1069
Practice Address - Country:US
Practice Address - Phone:317-355-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010109A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical